Provider Demographics
NPI:1790923480
Name:NEW JERSEY SPORTS MEDICINE LLC.
Entity Type:Organization
Organization Name:NEW JERSEY SPORTS MEDICINE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-998-8301
Mailing Address - Street 1:299 CHERRY HILL RD STE 105
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-1124
Mailing Address - Country:US
Mailing Address - Phone:973-998-8301
Mailing Address - Fax:973-998-8302
Practice Address - Street 1:299 CHERRY HILL RD STE 105
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-1124
Practice Address - Country:US
Practice Address - Phone:973-998-8301
Practice Address - Fax:973-998-8302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ153958Medicare PIN